Outcomes of Pediatric Cataract Surgery at Menelik Ii Hospital Addis Ababa, Ethiopia: a Retrospective Cross-sectional Study

Abstract

Introduction & significance of the study: Pediatric cataract is the main cause of childhood blindness in East African Countries. Surgery is the only treatment for treating cataracts and the quality of services for pediatric cataract surgery has to be monitored. The bulk of Ethiopia's population is served by Menelik II Hospital (MH), which is also the country's first and largest eye facility. Most pediatric cataract surgeries in Ethiopia are performed at MH, where no clinical outcome study has been conducted. Objectives: This study aimed to determine the outcomes of childhood cataract surgeries in children aged below 16 years at Menelik II Hospital, Addis Ababa, Ethiopia. Study design: This was a hospital-based retrospective cross-sectional. Study method: All medical records of children aged below 16 years who underwent nontraumatic cataract surgery at MH between 1st January – 31st December 2019 were reviewed. Visual acuity and postoperative complications were the outcome measures. Results: A total of 83 patients’ medical records were reviewed. The male-to-female ratio was 1.1: 1. Nearly half of the patients (45.8%) were in the 1 to 5 years age category and 48.2% were from the urban area. Congenital and bilateral cataracts were in 61.4% and 66.7% of the patients respectively. At presentation, uncorrected visual acuity was poor (<6/60) in 27.7% and can’t fix and follow in 24.8 %. The commonest types of cataract surgeries performed were LWO+IOL in 32.1% and LWO+PPC+IOL in 22.6% of the eyes. Out of the eyes with implanted IOL, 69% of the eyes had PMMA IOL. Half of the implanted IOLs (53/98) were not undercorrected according to the pediatric IOL implantation guideline. On the last postoperative follow-up visit, 52.5% of the eyes had Good visual outcomes according to WHO guidelines. Half of the eyes (49.6%) had postoperative complications with PCO accounting for 37.9%. Nystagmus (p-0.016) and congenital cataracts (p-0.005) were significantly associated with poor visual outcomes. Conclusion: Half of the eyes with quantitative visual acuity measurement had Good postoperative visual outcomes (³6/12) at the last follow-up visit. The commonest postoperative complication was PCO. Poor visual outcome was significantly associated with nystagmus and congenital cataracts. Recommendations: Primary posterior capsulotomy and anterior vitrectomy should be performed especially in those children less than 5 years of age. Intraocular lens undercorrection should be done according to the internationally recommended guidelines. Foldable IOL should be used especially in children less than 5 years of age.